Provider Demographics
NPI:1386830263
Name:J MATTHEW KNIGHT M D P A
Entity Type:Organization
Organization Name:J MATTHEW KNIGHT M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-992-0660
Mailing Address - Street 1:801 N ORANGE AVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1026
Mailing Address - Country:US
Mailing Address - Phone:407-992-0660
Mailing Address - Fax:407-992-7702
Practice Address - Street 1:801 N ORANGE AVE
Practice Address - Street 2:SUITE 520
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1026
Practice Address - Country:US
Practice Address - Phone:407-992-0660
Practice Address - Fax:407-992-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2019-04-12
Deactivation Date:2019-02-22
Deactivation Code:
Reactivation Date:2019-04-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH715Medicare PIN